建構口腔癌術後病人口腔評估表

Development of the Oral Assessment Scale for Post-Operational Patients With Oral Cancer

背景：目前國內外口腔評估表所適用的對象，以癌症病人接受放射線療法或化學藥物療法後口腔狀況評估為主，並非針對口腔癌術後病人整體口腔狀況所建構。然而一份具有信效度的口腔評估工具，能指引護理人員正確評估口腔癌術後病人口腔狀況，且能依評估結果來制定個別化口腔照護措施。目的：發展及建構口腔癌術後病人口腔評估表之信效度。方法　透過五場專家諮詢會議及5位專家二次內容效度檢定，編製完成十題項「口腔癌術後病人口腔評估表」，於南部某一醫學中心之口腔顎面外科加護病房及一般病房，收案30位及100位入院接受口腔惡性腫瘤切除、手術治療前未接受過化學治療或放射線治療者，分別進行預試及正式測試，以兩位評估者於預試階段檢定評估者間信度，於正式測試階段檢定量表之內在一致性信度及同時效度。結果　本量表之專家效度指標CVI（content validity index）值為1.0；預試評估者間信度除評估題項「唇」及「舌」ICC（intraclass correlation coefficient）值為.97外，其餘八題項皆為1.0；整體Cronbach's α係數為 .72。口腔狀況及口腔舒適程度呈顯著負相關（r = -.93, p ＜ .001）。結論／實務應用　「口腔癌術後病人口腔評估表」具有適當信度及效度，可用以評估口腔癌術後病人口腔狀況。

Background: Current oral assessment scales are designed to assess the severity of oral health in cancer patients who have undergone radiotherapy or chemotherapy. Currently, no scale is available that assesses the overall oral health situation of patients. However, this type of scale is critical for guiding nursing staff to understand the oral status of postoperative patients and for facilitating the development of patient-centered oral nursing treatments. Purpose: To develop the oral assessment scale for post-operational patients with oral cancer (OASPOCa) and establish its psychometric properties. Method: The ten associated items of the OASPOCa were determined using a series of five professional council meetings and two verifications of content validity by 5 experts in the field of oral cancer care. A pilot study was conducted on 30 participants and a formal study was conducted on 100 participants at the ICU and the oral and maxillofacial surgery ward at a medical center in southern Taiwan. All of the participants were oral cancer patients who had been admitted to excise tumors of oral cancer. None of the participants had been treated previously for oral cancer using chemotherapy or radiotherapy. The intraclass correlation coefficient (ICC), internal consistency reliability, and concurrent validity of the OASPOCa were evaluated. Result: A content validity of 1.0 was obtained. The inter-rater reliability assessment in the pilot study yielded ICCs of .97 for two assessment items (＂lips＂ and ＂tongue＂) and 1.0 for the remaining eight items. The Cronbach's α coefficient was .72 for the OASPOCa. Further, a statistically significant negative relationship was found between overall oral status and oral comfort level (r = -.93, p ＜ .001). Conclusions / Implications for Practice: The oral assessment scale for post-operational patients with oral cancer was found to have good reliability and validity. This scale is a reliable tool for assessing the oral status of postoperative oral cancer patients.